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An earlier report on the Nigerian expanded programme on immunization (EPI), covering 1974-1988, failed to demonstrate a clear-cut impact of the programme. This report attempts to determine the effectiveness of EPI in Borno State, Nigeria. We analysed trends in routine notifications for diphtheria, pertussis, tetanus, tuberculosis, measles, and pneumonia, from 1985 to 1991; data on poliomyelitis were excluded because of poor documentation, while we included data on pneumonia for comparison. We also performed a before (1983-1987) after (1988-1991) comparison in terms of the intensifications of EPI by age-specific strata amongst paediatric hospitalization for all EPI diseases at the University of Maiduguri Teaching Hospital, the sole referral hospital for childhood infectious diseases. Our results show an apparent reduction in morbidity from diphtheria, pertussis, tetanus, measles and pneumonia, and this was particularly prominent following intense vaccinations between 1988 and 1991. The reduction in these EPI diseases and pneumonia occurred despite the prevailing adverse socioeconomic conditions, and the absence of a specific control strategy for pneumonia in Nigeria. On the other hand, in spite of national BCG coverage of about 90% there has been a recent (1989-1991) increase in the registered cases of tuberculosis in infants and older children in Borno State. There is a need to intensify other intervention measures alongside EPI activities.
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PMID:The EPI in Borno State, Nigeria: impact on routine disease notifications and hospital admissions. 146 Jun 96

Swaziland is a kingdom with 800,000 inhabitants bordering on Mozambique and South Africa with about 50% of the population under 15 years of age. The experience of a nurse in a small clinic in the course of several years is recounted. Swaziland ranks 3rd in the world in alcohol abuse which often leads to wounds requiring suturing. Penicillin is given prophylactically with a paracetamol preparation for analgesia. As a rule, every injured person will get a .5 ml tetanus injection for prophylaxis. The most serious conditions of polyclinic patients are hepatitis, bilharzia, diarrhea, pellagra, pneumonia, and malnutrition. A great number of patients have sexually transmitted diseases, and the rate of AIDS infection is not known. According to 1 study 60-80% of the population in reproductive age will die of AIDS in the course of a 5-year period. The majority of people are impervious to counseling about their sexual behavior in spite of educational programs on the radio, in schools, and in work places. Condoms are not popular, since they are not considered manly. Pregnant women receive iron and multivitamin tablets in the course of pregnancy. Many pregnant women are anemic, and 70% give birth at home, the rest in a hospital or clinic. During delivery they get no analgesia, and there are few complications. The average weight of the newborn is 3.5 kg, although none of the women are under 150 cm. A little after birth all children are vaccinated with bacillus Calmette-Guerin (BCG) and polio, later with diphtheria-pertussis-tetanus (DPT) and measles.
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PMID:[Nursing under a different sky. Swaziland]. 146 29

In Niger, mobile health teams provided the first health services for nomadic populations, but these services have proved ineffective and costly. Since 1971, many dispensaries have been established in the rural areas to perform immunization. A 1990 evaluation of the Agadez region, in the northeast showed poor returns on investments. Immunization has been carried out by the mobile medical service since 1968 using 2 teams, each comprising 2 nurses, 2 vaccinators, and a driver/guide. The Expanded Program on Immunization (EPI) was launched in 1988 with both mobile teams and fixed health services. By the end of the year the region had achieved coverages of 40% for BCG (bacillus Calmette-Guerin) in children 1 year of age, 54% for 3rd dose of diphtheria-pertussis-tetanus (DPT3) immunization, 35% for children protected against tetanus, and 47% for 2nd dose of tetanus toxoid. The mobile medical service provided less than 10% of first dose DPT (DPT1) and measles immunizations and under 5% of DPT3 coverage which continued in the first 6 months of 1991. A survey in Mali during 1974 showed that the per capita cost of immunization by mobile units was 11 times higher than that performed by fixed units. The health district consists of the rural dispensaries, the first point of contact for patients who may have to travel up to 30 kilometers; and medical posts, which are intermediate referral facilities usually with an ambulance vehicle. These 2 types of health services cannot cover the rural areas effectively and do not involve the community. Fixed health facilities should not be limited to a radius of 5 kilometers, they should establish seasonal circuits as the population moves, and 1 or more areas should be served by an intermediate fed health post. Health teams should carry out immunization and family planning, as well as the education and the supervision of first level workers. In the nomadic areas, every health district should have at least 1 health post.
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PMID:What health system for nomadic populations? 146 27

Outbreaks of vaccine preventable infections have focused attention on 'missed opportunities' for immunizing children. The immunization status of 520 consecutive children attending Casualty during a 10 day period was studied. Only 70% of children had received their diphtheria, tetanus, pertussis (DTP) and poliomyelitis immunization at the appropriate time, 13% had completed the schedule later than recommended and 17% had immunizations overdue by 4 weeks or more. For measles (mumps/rubella) vaccine (MM or MMR) 75% were up to date, 10% were given late and 15% were overdue. A subset of 171 families was interviewed to evaluate factors affecting compliance. Families possessing a Social Security 'Health Care Card', whose father was unemployed, who spoke poor English or who had lived in Australia for 5 years or less were significantly more likely (P < 0.02) to be inadequately immunized. There were 84 children whose immunization was overdue and who were well enough to be immunized. The parents of 70 (83%) of these 84 said that they would agree to 'on the spot' immunization if it were available; 14 (17%) parents refused, the commonest reason for refusal being that the parents felt that the child was too sick at the time to be immunized.
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PMID:Immunization status of casualty attenders: risk factors for non-compliance and attitudes to 'on the spot' immunization. 146 42

The age-specific efficacy of a vaccine depends upon the mechanism of vaccine action and the force of infection in the unvaccinated subpopulation. Consequently, inferences concerning the persistence of vaccine-induced immunity cannot in general be made directly from age-specific vaccine efficacy estimates. The definition, estimation and interpretation of age-specific vaccine efficacy measures are discussed using simple models of vaccine action. The methods are applied to data on measles and pertussis vaccines.
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PMID:The measurement and interpretation of age-specific vaccine efficacy. 146 38

Dramatic changes have been made in the recommended schedule for immunizations, and for a variety of reasons: greater understanding of risks associated with whole-cell pertussis vaccine; introduction of more immunogenic vaccines to prevent invasive disease caused by Haemophilus influenzae type B; a national epidemic of measles that affected many vaccinated individuals; and the failure of targeted use of vaccine in high-risk patients to reduce the occurrence of hepatitis B. Additional changes in recommended regimens can be anticipated as new products are introduced. However, for vaccines to have their greatest impact, improved adherence to recommended immunization practices is necessary.
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PMID:Recent developments in vaccines and immunization practices. 148 May 5

During the 1970s and the early 1980s, immunization practices in the United States were unchanged. Immunization against pertussis, tetanus, diphtheria, measles, mumps, rubella, and polio were routinely administered to children. Infections with these organisms declined dramatically. Nonetheless, research was vigorous, culminating in the 1980s in new vaccines and changes in immunization strategies and practices. This presentation will focus on these changes: universal hepatitis B immunization; two-dose schedule for the measles, mumps, rubella (MMR) vaccine, Hemophilus influenza type B vaccine for infants, acellular pertussis vaccine as booster immunizations, the inactivated polio vaccine, and the yet-to-be-licensed live varicella vaccine.
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PMID:Immunization update. 149 Jun 20

In 1987 the nutritional status of Zambian children under 5 years of age was studied in 3 regions around Kamoto Hospital with the objective of exploring the prevalence if malnutrition and contributing factors such as maternal education and immunization status. Jumbe was within easy reach of the hospital with a relatively high standard of living. Masumba and Kakumbi were different areas in one region with their own health center further away from the hospital. Chibembe was isolated without good roads. The nutritional status of 1-5 year old children was measured by the Mid Upper Arm Circumference (MUAC). A questionnaire with 22 questions queried mothers about education, breast feeding, meals, water supply, and sanitation. A total of 1251 children were observed, 1222 under age 5, and 29 a little older. 40% of mothers had no education and 54% had some primary education (15.2% passed grade 4, 7.3% reached grade 6, and 18.2% finished grade 7). Less than 5% attended secondary school, and only 1% of mothers finished it. In Chibembe almost 50% of mothers had no education, secondary school education was the lowest of the regions, while in Jumbe was the highest. Immunizations included Bacillus Calmette-Guerin (BCG) at birth, diphtheria-tetanus-pertussis (DTP I, II, III, and a booster), oral polio vaccine (OPV) I, II, III, and a booster, and measles. The Chibembe region has the highest number of incomplete immunizations. In the Jumbe region unknown immunization presumably contributed to a higher number of older children. The nutritional status of children was the lowest in Chibembe region with a 10.8% rate of malnutrition and the lowest rate of maternal education. In Masumba/Kakumbi malnutrition was the lowest with 5.6%, while maternal education and complete immunization were the highest. The nutritional status of the completely immunized children was better. MUAC should be routinely employed for children under 5 years of age.
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PMID:Immunisation and nutritional status of under-fives in rural Zambia. 150 11

The relationship between certain host-related variables and the short-term outcome of hospitalization for severe acute lower respiratory infections was studied prospectively in a cohort of 103 pre-school Nigerian children. The respective mean ages of those with bronchiolitis and croup were 3.2 months and 18.9 months while the corresponding M:F ratios were 2.5:1 and 1:1. It was highly significant that all the eight children that died were malnourished (P less than 0.01). Furthermore, malnourished subjects with pleural effusion, in whom bacteraemia was common, stayed longest in hospital while subjects with bronchiolitis and croup, in whom malnutrition was distinctly uncommon, had the shortest duration of admission. Multiple microbial identifications and bacteraemia were common in malnourished subjects with ALRI. Mortality was significantly higher in older children (P less than 0.05), but sex, immunization/breast-feeding status and co-existing measles or pertussis, were individually neither related to the admission outcome nor the duration. It is concluded that malnutrition is a strong predictor of ALRI-related death in the pre-school child. The significance of bacteraemia and multiple microbial identifications in malnourished children, and the ARI-control implications of the study are discussed.
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PMID:Host factors and acute lower respiratory infections in pre-school children. 150 9

A repeat vaccination coverage survey has been conducted in the Edendale/Vulindlela district of KwaZulu. The survey data were processed using the Coverage Survey Analysis System (COSAS) developed by the World Health Organisation (WHO) through its Expanded Programme on Immunisation (EPI). A modified random cluster sampling method was used to select 281 children between the ages of 12 and 23 months. Of the children surveyed, 83% were in possession of Road-to-Health cards (RTHCs). The best estimate of overall coverage for doses up to and including the second doses of polio and diphtheria, pertussis and tetanus (DPT) was 85% or higher, but estimates for polio 3 and measles, at 72% and 67% respectively, remain suboptimal. Stratification of coverage into urban, peri-urban and rural categories revealed that the major contribution to the fall-off in coverage, after the second dose of polio and DPT, came from children in the peri-urban category with estimates of 52% for polio 3 and 38% for measles. The fact that coverage in the peri-urban population for doses up to and including polio 2 was 78% or higher indicated that the peri-urban influence responsible for this drop-out effect occurred between the approximate ages of 5 and 8 months. This identified populations in informal peri-urban settlements as a priority group for urgent intervention and further study. The estimation of missed opportunities at visits when vaccinations are normally given, found in this survey to occur in 17% of children, was a useful feature of COSAS and provided a basis for a specific intervention.
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PMID:The use of COSAS in the analysis of vaccination coverage in urban, peri-urban and rural populations in the Edendale/Vulindlela district of KwaZulu. 150 23


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